慢性血液透析患者的遗传学研究

在慢性疾病人,包括那些持续性血液透析的慢性肾炎病人中,传统、非传统危险因子和临床结果关联的逆转会经常遇到.在风险因子与临床结果的逆转中,营养不良-炎症反应综合征(MICS)的影响起主要作用.在普遍的持续性血液透析患者中,营养不良炎症复杂综合征并不普遍存在.在普遍的炎症、氧化应激、营养不良方面个体之间和个体内部之间的主要不同.表明了遗传因子变异的影响.最近几年,在分子遗传学、基因组学和生物信息学的巨大进展,引起了几种疾病的遗传流行病学研究的变革.然而,在慢性肾炎人群中遗传关联研究还只处于一个初步水平.在炎症和氧化应激有关的基因多态性的影响以及影响机体组成和代谢作用的基因多态性影响的初步研究表明:遗传变异确实可能影响到持续性血液透析人群的表型.此外,其中一些基因多态性也可能有助于扭转如体重指数、血压、胆固醇这些传统危险因素与在这些脆弱的患者群中临床疗效的关联.在包括充实足够数量的患者数来达到统计学要求,解决巨大的基因型和表型异质性以及基因-环境和基因-基因相互作用的影响,给晚期慢性肾炎病人的遗传学研究带来了巨大的挑战.     

慢性血液透析患者的遗传学研究

在慢性疾病人,包括那些持续性血液透析的慢性肾炎病人中,传统、非传统危险因子和临床结果关联的逆转会经常遇到.在风险因子与临床结果的逆转中,营养不良-炎症反应综合征(MICS)的影响起主要作用.在普遍的持续性血液透析患者中,营养不良炎症复杂综合征并不普遍存在.在普遍的炎症、氧化应激、营养不良方面个体之间和个体内部之间的主要不同.表明了遗传因子变异的影响.最近几年,在分子遗传学、基因组学和生物信息学的巨大进展,引起了几种疾病的遗传流行病学研究的变革.然而,在慢性肾炎人群中遗传关联研究还只处于一个初步水平.在炎症和氧化应激有关的基因多态性的影响以及影响机体组成和代谢作用的基因多态性影响的初步研究表明:遗传变异确实可能影响到持续性血液透析人群的表型.此外,其中一些基因多态性也可能有助于扭转如体重指数、血压、胆固醇这些传统危险因素与在这些脆弱的患者群中临床疗效的关联.在包括充实足够数量的患者数来达到统计学要求,解决巨大的基因型和表型异质性以及基因-环境和基因-基因相互作用的影响,给晚期慢性肾炎病人的遗传学研究带来了巨大的挑战.     

血液透析患者慢性炎症反应状态

血液透析是终末期肾病 (ＥＳＲＤ)的主要治疗方法 ,尽管这一技术已日趋成熟 ,但是终末期肾病患者死亡率仍然较高 ,并与许多因素相关 ,如高龄、心血管合并症、糖尿病、营养不良、低白蛋白血症、感染等。有研究表明〔1〕,在所有年龄组的透析患者中 50 %死于心血管疾病 (包括心脏骤停、急性心肌梗塞和其它心血管疾病 ) ;在 2 2～ 40岁、45～ 64岁和大于 65岁年龄组 ,死于感染性疾病分别占2 5%、1 7%和 1 4% ;营养不良在透析患者中发生率约为 34%～ 60 %。Ｋａｙｓｅｎ、Ｚｉｍｍｅｒｍａｎｎ等〔2～5〕 研究表明 ,30 %的慢性血液透析患者血浆Ｃ…     

血液透析患者营养不良研究近况

血液透析患者营养不良研究近况张道友综述赵振东审校血液透析患者常有营养不良，致使死亡率增加，近年这一问题越来越为人们所重视，不少学者对此进行充分而细致的研究，兹就有关文献综述如下。一、营养不良和死亡率间的关系长期血透（ＨＤ）患者进低蛋白饮食，蛋白分解率...     

血液透析对慢性肾功能衰竭患者透明质酸的影响

本文测定了16例CRF患者SHA、UHA的水平,并对11例HD病人HD前后变化进行观察,及36例健康人SHA、UHA作对照,发现CRF和HD病人SHA明显升高(P<0.01),UHA明显下降(P<0.01);HD病人HD后SHA明显下降(P<0.01);CRF组SHA和Scr呈正相关,而UHA和Scr呈负相关。以上结果表明:SHA和UHA是CRF病情变化的敏感标志,对肾功能损害程度有监测作用,且HD可以纠正高HA血症。     

Extrapulmonary Tuberculosis in Chronic Hemodialysis Patients

Background.?The incidence of extrapulmonary tuberculosis is higher in dialysis than general population. The aim of the study was to characterize clinical picture in dialysis patients, who developed extrapulmonary tuberculosis. Methods.?We retrospectively investigated the hemodialysis patients with extrapulmonary tuberculosis. 2208 hemodialysis patients were reviewed for extrapulmonary tuberculosis from 10 1986 to 01 2001. Results.?Seventeen patients (10 male, 7 female) were enrolled. The mean age was 57.4 ± 12.4 years. The sites for extrapulmonary tuberculosis were peritoneum (35.3%, 6/17), cervical lymph node (17.6%, 3/17), bone marrow (5.9%, 1/17), spine (5.9%, 1/17), knee (5.9%, 1/17), brain (5.9%, 1/17), pericardium (5.9%, 1/17), cutaneous tissue (5.9%, 1/17) and genitourinary system (5.9%, 1/17). Fourteen of 15 tissue-biopsy specimens from suspicious sites revealed granulomatous inflammation. There were low yield in mycobacteria culture (11.1%, 1/9) and PCR (33.3%, 2/6). Three patients died during the treatment of the disease. Conclusion.?Extrapulmonary tuberculosis constitutes a major part of tuberculosis in dialysis patients. Tissue biopsy with invasive procedures, such as laparoscopy or laparotomy, may be necessary if clinical presentations are suspicious.     

Identifying and Classifying Bloodstream Infections Among Hemodialysis Patients

Bloodstream infections (BSIs) are a prominent clinical problem in patients undergoing hemodialysis. These infections appear to be more common among patients who have a central line as their dialysis access and can be associated with substantial morbidity and mortality. Accurately diagnosing BSIs clearly influences patient management, but is also an important part of an infection prevention program; particularly as facility BSI rates are becoming a recognized quality measure for which dialysis facilities might be held accountable. Blood cultures remain the gold standard for diagnosing BSIs and a number of practices can affect the sensitivity and specificity of this important laboratory test. Optimizing the collection of blood cultures can assist providers with interpretation of positive blood cultures and can help minimize the impact of false‐positive and false‐negative cultures. This review will describe differences between BSI definitions, examine the use of blood cultures to identify these infections including the use of recommended best practices to maximize culture yield, and highlight characteristics that can assist in the clinical interpretation of positive blood cultures.     

Survival of Patients on Chronic Hemodialysis: Single Center Experience

Patient survival from our hemodialysis (HD) center over the past 11 years was analyzed. Four hundred four patients, 212 female and 192 male, were treated by chronic intermittent HD. Patients were offered standard acetate-cellulosic membranes of 1.0–1.3 m². During this period 181 patients died. One hundred three patients were transferred to other HD centers, and some were transplanted. One hundred twenty patients are still on HD treatment. The 5 year survival rate of patients treated in our center was 58%. Women lived longer than men, and age correlated significantly with survival rate. Patients with chronic glomerulonephritis and adult polycystic kidney disease had the best survival rates while diabetic patients and those with post hypertensive nephropathy had the poorest survival rates. Forty-four percent of patients had a cardiac related cause of death, cerebrovascular accident was the cause in 15%, and 11 % died due to septic condition (infection) while 8% died due to liver disease.     

Knowledge of Chronic Hemodialysis Patients on Kidney Transplantation in Morocco

BackgroundKidney transplantation (KT) is the optimal treatment for chronic end-stage renal failure. However, it is experiencing a huge delay in Morocco, and the lack of information on this alternative treatment could contribute to this delay. The purpose of our work is to evaluate the knowledge of hemodialysis (HD) on renal transplantation and to propose sensitization and information strategies.MethodsThis is a multicenter study conducted in 4 hemodialysis centers in Marrakesh from November to December 2017. An individual questionnaire was submitted to 310 patients concerning sociocultural status, willingness to be transplanted, the main benefits and risks of renal transplantation, knowledge of religious attitudes toward organ donation and transplantation, cost, and survival of the KT.ResultsOf the 310 patients, 56% were men, with a mean age of 49.43 ± 10.3 years. The mean duration of hemodialysis was 6.7 ± 5.3 years. Only 18% were in school, and 57% had moderate economic status. Of the 310 respondents, 71% said they wanted to be transplanted, and 15.5% believed that Islam was unfavorable by encouraging them to accept the fate that God chose for them. The rest were afraid of multiple complications and returning to dialysis. However, 41.7% thought transplantation was more expensive than hemodialysis. Only 65.8% believed that renal transplantation provided a better quality of life.ConclusionsRaising the awareness of hemodialysis patients and their families is essential to promote KT in Morocco.     

Allergy to Ethylene Oxide in Chronic Hemodialysis Patients

Almost a decade ago, a single chronic hemodialysis patient in Hamilton, Ontario, Canada, who was experiencing recurrent acute reactions during hemodialysis was found to have become allergic to ethylene oxide gas (EO). This observation recently provided a stimulus to examine the possibility that others exhibiting acute allergic-type reactions during hemodialysis might be similarly sensitized. Serum was obtained from 27 reacting patients and tested in a radioallergosorbent test (RAST) for antibodies to EO. The test was positive for 22 of these sera. EO-related specificity of the antibodies was confirmed. However, EO sensitization was not found in other hemodialysis patients with isolated eosinophilia. In a survey of the current Hamilton chronic hemodialysis population for EO-related antibodies, 9% had a positive allergy skin test and 12% had a positive RAST. The sensitized individuals had no distinctive symptoms. The lesser sensitivity of the skin test contrasts with usual findings in allergic individuals; however, the use of histamine and codeine in chronic hemodialysis and peritoneal dialysis patients might well explain a reduced sensitivity of the EO-related allergy skin test. Chronic peritoneal dialysis could not be invoked as a source of sensitization. None of these patients had a positive skin test or RAST for EO-related antibodies that could be attributed to peritoneal dialysis.     

424例血液透析患者睡眠状况的人口学特征分析

目的：通过对424例血液透析患者睡眠状况的社会人口学特征分析,为临床治疗护理提供信息。方法：采用便利取样,使用匹兹堡睡眠质量指数量表及自设的一般情况调查表调查中山大学附属第一医院等7家医院424例维持性血液透析患者的人口学特征及睡眠状况。结果：有93.2%的患者PSQI总分≥5分,不同性别、婚姻状况的患者睡眠质量指数差异无统计学意义,而不同年龄、文化程度、经济收入及不同职业的患者得分差异有统计学意义。结论：血液透析患者睡眠质量指数得分比国外研究的水平高,不同的年龄、职业、文化程度、经济收入对患者的睡眠有一定的影响,应采取相应的措施。     

Endothelin-1 and Nitric Oxide in Patients on Chronic Hemodialysis

Aim. To establish the role of endothelin-1 and nitric oxide in the pathogenesis of hypertension in patients on chronic aemodyalisis by correlating endothelin-1 and NO plasma concentrations to the level of arterial hypertension with respect to angiotensin-converting enzyme (ACE) inhibitor therapy. Methods. We determined plasma concentrations of endothelin-1 and NO in patients on chronic hemodialysis (CHD) before and after hemodialysis treatment. The study included 30 CHD patients and 20 healthy participants as controls. Correlation to blood pressure was determined, as well as the effect of ACE inhibitors on the relationship between both endothelin-1 and NO in correlation with arterial hypertension. Main findings.Endothelin-1 plasma concentration was significantly higher in CHD patients before hemodialysis treatment than in healthy controls. Endothelin-1 plasma concentration was also significantly higher in CHD patients after hemodialysis than in healthy controls. There was a significant decrease in endothelin-1 plasma concentration after hemodialysis in comparison with its values before hemodialysis. In CHD patients, a positive correlation was found between endothelin-1 plasma concentration and systolic blood pressure after hemodialysis, irrespective of ACE inhibitors therapy. In CHD patients taking ACE inhibitors, systolic blood pressure increased with increasing endothelin-1 plasma concentration before as well as after hemodialysis. In patients taking ACE inhibitors, there was a tendency for diastolic blood pressure to increase with an increase in endothelin-1 plasma concentration after hemodialysis and to decrease with an increase in NO plasma concentration. Conclusion. NO and endothelin-1 play a significant role in etiology of the hemodynamic changes of blood pressure during the dialysis.